Dr Peter J Gordon: “As a critical friend”: awareness campaigns [reblogged]

Hole Ousia

I have just read:009 as a critical friendIt begins: [we]010 as a critical friend011 as a critical friendAs a doctor who openly asks questions I see great value in being a “critical friend”:008 as a critical friendThe Alzheimer Scotland Strategic Review outlines significant progress:012 as a critical friendThis is the current campaign by Alzheimer Scotland of which I have expressed concerns as a “critical friend”2 Feb 2015 Alz Scot early diagnosis a This Alzheimer Scotland campaign promotes early diagnosis:014 as a critical friendYet just a few months before this campaign was launched, Alzheimer Scotland:015 as a critical friendThe Glasgow Declaration, signed here by the then Cabinet Minister for Health, Alex Neil, enshrined “timely diagnosis”. It has now been signed by 1815 individuals and 50 organisations across Europe. As an international agreement it does not advocate early diagnosis.Glasgow-declaration signed Dr Margaret McCartney asked in her book “The patient paradox”:  001 as a critical friendand then offers this concern:002 as a critical friendAge related memory loss, that is not dementia, can be a reality for us all as we age. It is however very far from inevitable. Such mild…

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The Glasgow Declaration: “the progressive test” by Dr Peter J Gordon #HoleOusia

Hole Ousia

As a tireless advocate for a timely approach to the diagnosis of dementia I was delighted to be there in person when the “Glasgow Declaration” was signed. This rights-based declaration enshrined the right for a timely diagnosis as well as promoting dignity and autonomy.

The Glasgow Declaration from omphalos on Vimeo.

Those that signed the declaration included members of the Scottish Government, Alzheimer Scotland and the Mental Welfare Commission. Since then, over 50 organisations across Europe have signed the “Glasgow Declaration”.

Glasgow declaration April 2015

In my last post I considered consent for “cognitive screening” and whether the current NHS Scotland approach fulfilled the criteria for “the progressive test” as set out by the Scottish Human Rights Commission.

009 Progressive Test

Six months on from the launch of the Glasgow Declaration, I want to ask if recent developments in Scotland, by (1) Alzheimer Scotland and (2) the Dementia Services Development Centre fulfill the criteria necessary to…

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Dr Peter J Gordon: “Packaging up old myths” #HoleOusia [reblogged]

Hole Ousia

Last week the Association of the British Pharmaceutical Industry (ABPI) held its Annual Conference:Annual Conference 2015The Pharmaceutical Industry are concerned about an “affordability conundrum”:Affordability conundrum1The affordability conundrumThis BBC Report from November 2014: “Pharmaceutical Industry gets high on fat profits” documented that:Pharmaceutical industry gets high on fat profits (2b)There will be many companies around the world who would like to be dealing with this kind of “affordability conundrum”.

Another area of concern to the industry was discussed at the 2015 ABPI Conference:Aileen Thompson 2aileen_thompsonThe closing session of the 2015 ABPI Conference was focused on the reputation of the pharmaceutical industry:  Industry as a credible partner A panel discussion was part of this:      Sponsored by concentraI wonder if the panel considered this:Pharmaceutical industry gets high on fat profits (3)Andrew McConaghie of PharmaPhorum recorded this passage:wrong1wrong2wrong3My view is that if the Pharmaceutical industry are concerned about their reputation then they should avoid such obvious scapegoating. Dr Goldacre has been and continues to be a world pioneer for scientific objectivity and it does…

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‘Dodging Abilify’ by Johanna Ryan @RxISK [reblog]

rxisklogoDodging Abilify‘ by Johanna Ryan on RxISK website:

Editorial Note:  This post is by Johanna Ryan, who has a unique ability to capture the American Nightmare 

The best-selling drug in the United States isn’t a blood pressure pill, a painkiller or even an antidepressant.  It’s Abilify, an antipsychotic agent with $6.3 billion in 2013 sales.  Granted, Abilify isn’t the most prescribed pill, but its #1 status is sealed by popularity and high price: the current retail price of a 30-day supply is now a whopping $900, and it’s 23rd in sheer numbers of prescriptions.  In 2011 the Medicaid program in my home state of Illinois spent $53.6 million on Abilify for its poorest citizens, more than it spent on any other drug.

I’m not the first to ask, what the hell is going on here?  However, my interest in Abilify is personal:  Wherever I go in the healthcare system, people have been urging me to take it, and even suggesting there’s something irrational about my reluctance.

Phase 1: Dodging bipolar disorder

A brief word about my situation:  I’ve been treated for depression, at times severe, since 1975.  Over the years I’ve been unable to work for brief periods, fairly miserable but officially “functional” more often.  Still, I’ve never once experienced psychotic symptoms.  No voices, no visions, no strange beliefs or fears, and no “manic” periods of wild activity and grandiose plans.  Back in the 1980’s I was hospitalized a few times as actively suicidal, and was once given antipsychotics – but only for the first week or so.  I didn’t like them then; I felt more passive than truly calm, and unable to complete an intelligent thought.

Having watched the rollout of “new and improved” antipsychotics in the 1990’s that turned out to have just as many problems as the old ones, I still don’t like them.  However, it wasn’t until 2006 that I really got skeptical about psychiatric drugs in general.  Despite a long trail of meds that had done me no good, stopped working or had miserable side effects, I was always willing to try the next milestone in the march of science – unless it was an antipsychotic.

Ten years ago, the new antipsychotics were easy to refuse.  The theory behind giving them to people like me was that repeatedly depressed people might have “bipolar disorder type II”, a mood disorder without actual mania, and should take these drugs as “mood stabilizers.”  My longtime psychiatrist, Dr. A, knew me too well to really believe I was bipolar; he told me he thought it made little difference what label he put on my depression since none of them could be verified.  Still, he thought these drugs well worth a try.  “They’re not necessarily antipsychotics,” he said. “That’s just a label, they’re used for lots of things.”  “I know,” I replied, “but they’re still neuroleptics. I want to hang on to all the brain function I can.

“Oh, come on,” he coaxed.  “We’re talking about little baby doses here, just a fraction what they give people for schizophrenia.”  That sounded somewhat reassuring – but I still said no. (Today I’m glad I didn’t listen to that particular sales pitch, as I’ll explain later.)

Back in those days, I could tell a family doctor, OB/GYN or nurse that Dr. A wanted me to take antipsychotics, and they’d look bewildered.  Even flinch a bit.  “But you’re not… I mean …”  “Right,” I’d say. “Not psychotic.  And unless and until I start hearing voices, I’m not touching that stuff.  Even if I do start hearing voices, I’m not taking it a day longer than I have to.”  They all thought that made sense. …”

Read complete RxISK post

image from RxISK post

image from RxISK post

‘The Role of Video Games and Virtual Reality in Psychiatric Treatment’ & ‘The Benefits of Playing Video Games’ articles

The Role of Video Games and Virtual Reality in Psychiatric Treatment‘: David Baron, Marientina Gotsis, Psychiatry Advisor, 8 April 2015

Introduction:

“Individuals and families of all ages are consumers of interactive entertainment in many forms. Games have matured as an artistic medium and they now explore emotional experiences that represent a wide spectrum of human emotions.

The game Journey, which has been dubbed by critics as a cinematic experience, is being used in clinical studies for depression at the Behavioral Sciences Institute (BSI) in Radboud University Nijmegen in Holland. The BSI is also behind of Mindlight, a sweet-scary biofeedback-driven game for children with anxiety. Its aesthetic merit beyond clinical applications has landed it at the Games for Change festival in New York City this month….”

Excerpts:

“Unfortunately, as the public lives increasingly in a networked and digital world, psychiatry remains deeply skeptical and removed from technological advances for going beyond patient engagement to interactive diagnostics and treatment. Interactive entertainment elicits emotions, can help regulate affect, and can provide “virtuous” pleasure of an epicurean era in which happiness (ataraxia) is the absence of unnecessary mental and physical suffering. But why isn’t all this technology being used widely by psychiatry? …”

“One of the most promising opportunities is to replace neurocognitive instruments with cross-validated entertainment-based experiences. This would be especially useful in developmental disorders.

Understanding how the design of interactivity affects brain function, and how that maps to executive function development trajectories, is especially critical for use of these experiences by children. …”

Read complete article

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The Benefits of Playing Video Games‘: Isabela Granic, Adam Lobel, and Rutger CME Engels; Radboud University Nijmegen; January 2014; American Psychologist

Abstract:

“Video games are a ubiquitous part of almost all children’s and adolescents’ lives, with 97% playing for at least one hour per day in the United States. The vast majority of research by psychologists on the effects of “gaming” has been on its negative impact: the potential harm related to violence, addiction, and depression. We recognize the value of that research; however, we argue that a more balanced perspective is needed, one that considers not only the possible negative effects but also the benefits of playing these games. Considering these potential benefits is important, in part, because the nature of these games has changed dramatically in the last decade, becoming increasingly complex, diverse, realistic, and social in nature.

A small but significant body of research has begun to emerge, mostly in the last five years, documenting these benefits. In this article, we  summarize the research on the positive effects of playing video games, focusing on four main domains: cognitive, motivational, emotional, and social. fig1 videogames 23apr15

By integrating insights from developmental, positive, and social psychology, as well as media psychology, we propose some candidate mechanisms by which playing video games may foster real-world psychosocial benefits.  Our aim is to provide strong enough evidence and a theoretical rationale to inspire new programs of research on the largely unexplored mental health benefits of gaming.  Finally, we end with a call to intervention researchers and practitioners to test the positive uses of video games, and we suggest several promising directions for doing so.”

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‘God put a thought into my mind’: S Dein & CCH Cook; Mental Health, Religion & Culture

untitledGod put a thought into my mind: the charismatic Christian experience of receiving communications from God‘: Simon Dein & Christopher CH Cook, Mental Health, Religion & Culture, Volume 18, Issue 2, 2015

Abstract: “The agentive aspects of communicative religious experiences remain somewhat neglected in the social sciences literature. There is a need for phenomenological descriptions of these experiences and the ways in which they differ from culturally defined psychopathological states. In this semi-structured interview study, eight congregants attending an evangelical church in London were asked to describe their experiences of God communicating with them.

Communications from God were related to current events rather than to the prediction of future events. These communications were received as thoughts and do not generally reveal metaphysical insights, but rather they relate to the mundane world. They provided direction, consolation and empowerment in the lives of those receiving them. Individuals recounted that on occasion God sometimes speaks audibly, or accompanied by supernatural phenomena, but in the vast majority of cases, the way God speaks is through thoughts or impressions. In all instances, agency is maintained, individuals can choose to obey the thoughts/voices or not. The findings are discussed in relation to externalisation of agency and the phenomenon of thought insertion in schizophrenia.”

Introduction: “The sheep follow him because they know his voice. John 10:4b NRSV
As the controversial psychiatrist Szasz (1979, p. 101) quipped: “If you talk to God, you are praying; If God talks to you, you have schizophrenia. If the dead talk to you, you are a spiritualist; If you talk to the dead, you are a schizophrenic”. While mental health professionals have a long tradition of pathologising religious experience (Johnson & Friedman, 2008), it appears that things are slowly changing. The recent DSM-5 (American Psychiatric Association, 2013) states:

The judgement that a given behaviour is abnormal and requires clinical attention depends on cultural norms that are internalised by the individual and applied by others around them, including family members and clinicians. Awareness of the significance of culture may correct mistaken interpretations of psychopathology …  (p. 14)

Like the early DSM –IV-TR , DSM-5 includes a V Code, 62.89, religious or spiritual problem. However, it also provides an expanded understanding of culture and the impact of culture in diagnosis.

Dein (2010) notes that we lack detailed phenomenological accounts of religious experiences involving communication with God and their differences from culturally defined psychopathological states. In this respect, the current paper examines how a group of Evangelical Christians in London perceive God to be communicating with them through the insertion of thoughts into congregants’ minds. It builds upon recent work on hearing God’s voice among Christians which suggests that hearing God is normative in some groups and that these voices differ phenomenologically from those found in schizophrenia (Dein & Littlewood, 2007; Luhrmann, 2012).”

“Can’t – won’t – no point” Dr Peter J Gordon [reblog]

Hole Ousia

This article published in the London Review of Books by Dr Gavin Francis has generated much discussion:LRB - cash for diagnoses - Gavin Francis

This BMJ poll asked about the ethics of NHS England’s approach:BMJ pollProfessor June Andrews, “International Dementia expert, consultant, teacher, nurse, writer and researcher” submitted the following response which was published alongside the original article by Dr Francis: LRB - cash for diagnoses - June Andrews

Not surprisingly, the suggestion that GPs should be sued (introducing a stick as well as the carrot of the £55) attracted a lot of responses from GPs. Dr Margaret McCartney, GP in Glasgow, Medical author and regular columnist in the BMJ, replied to Professor Andrews:Mgt replies

Professor June Andrews replied initially on social media, stating:JA quote

Professor Andrews then submitted a fuller reply on Dr McCartney’s blog, which can be read here along with further replies. Professor Andrews appears to have been surprised by the reaction to her forthright suggestion. I have followed the discussions on social…

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